This invention relates to a data processing system for accurately calculating a policyholder's discount in a medical insurance plan and to a method therefor.
Good management of a medical insurance plan, typically a private medical insurance plan, is obviously important to the plan managers to ensure the ongoing financial viability of the plan. However, in recent years, in some countries, there has been a change in the management of a medical insurance plan to focus on the policyholders of the plan and to encourage the policyholders of the plan to stay healthy. To date, this has not been a discernible trend in the United Kingdom.
Examples of the developments in this area are described in South African patents numbers 99/1746 and 2001/3936, the contents of which are incorporated herein by reference.
Another method of managing a medical insurance plan that is focused on encouraging the policyholders of the plan to manage their claims is to offer the policyholders a discount based on the mount of premiums paid to the medical insurance plan, the amount of claims made from the medical insurance plan and possibly the level of the policyholder in an incentive scheme associated with the insurance plan. This approach addresses two latent problems inhering in insurance in general, namely moral hazard, whereby policyholders may be incentivised to claim and adverse selection, whereby high-risk individuals are attracted to purchase the insurance plan. In addition, the approach mitigates the tendency in private medical insurance to reward sickness.
However, the practical implementation of such a method poses technical difficulties as it is not simple to determine the amount of premiums paid to the medical insurance plan and the amount of claims made from the medical insurance plan. This is because the amount of premiums paid can change suddenly if a policyholder changes their plan options, for example. Also, the amount of claims made can vary if there are claims which have been submitted but have not yet been processed or if there are claims which are under dispute, for example. Simply to take a snapshot of how much premiums has been paid in a given period and how many claims have been paid out to the policyholder would not give accurate amounts for use in determining an appropriate discount.
The present invention provides a data and rules processing system for accurately calculating a policyholder's discount in a medical insurance plan and to a method therefor.